Individual
MARIANNE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
2381 E SUNNYSIDE RD, IDAHO FALLS, ID 83404-7521
(208) 904-4780
Mailing address
3040 TIPPERARY LN, IDAHO FALLS, ID 83404-7317
(801) 682-7947
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
56225
ID
Other
Enumeration date
08/14/2022
Last updated
08/14/2022
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